Effects of strategy changes in the treatment of femoral neck fractures during a 17-year period.

From 1966 to 1982 new concepts in the treatment of fresh femoral neck fractures were introduced at a university hospital in Sweden. These included immediate postoperative weight-bearing, a program with rehabilitation at home in collaboration with primary care, and an alteration of the treatment policy from primary hemiarthroplasty to a flanged nail and finally to hook pins. The total annual number of hospital days was reduced by about one-third during this period in spite of the fact that the annual number of femoral neck fractures doubled. Thus, the mean hospitalization time decreased from 44 to 16 days. The proportion of patients admitted from their own homes decreased from 80% to 52% during the 17-year period, and for these, the return rate home at discharge from the hospital increased from 44% to 75%. According to several reports from Scandinavia, the number of hip fractures will double in the next two decades. Ways of further reducing the hospitalization time, new techniques, and, if possible, methods of preventing hip fractures must be sought.